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General NPI Number Information
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NPI Number | 1477171973
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Entity Type | Organization
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Legal Business Name | TELEDENTIST365 FOUNDATION
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Dates
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Enumeration Date | 07/10/2020
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 2111 LIMRICK DRIVE
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City | PEARLAND
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State | TX
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Zip | 77581
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Country | US
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Telephone | 301-758-6885
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Fax |
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Provider Business Mailing Address
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Address Line | 133 N FRIENDSWOOD DR STE 187
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-3746
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Country | US
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Telephone | 301-758-6885
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. CHIOMA IMO
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Credential | DDS
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Telephone | 301-758-6885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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